I want to give a shout out to my old yoga studio in Richmond, VA: Yoga Source. Their extraordinary teachers, especially Tia Platte, helped me to become skilled in chaturanga AND in knowing when to back off from doing chaturanga dandasana. Forever grateful to Yoga Source (Yogarichmond.com) for embracing me into their community of skilled and deeply dedicated teachers. <3! Muah! miss you all!

Full question: I had a conversation with a yoga instructor recently about how it seems yoga has become like a competitive sport as the US has adopted it. I told her I took yoga classes over a decade ago from a gentle, motherly, artist woman (my friend’s mom) who taught yoga out of her home, and since then I had been doing yoga on my own. The teaching philosophy of my first yoga teacher had been that no one should ever try to stretch further than they can. For example, a first time yoga student will probably not be able to touch their toes, especially if they are overweight. My first instructor would tell us it’s okay to do a pose as close to what she was doing as they could, but would caution not to overextend, and only to do what is comfortable for them. She would say it’s alright if you can only get halfway into the full pose. This allowed us to focus on enjoyment of the gradual changes that take place toward becoming more flexible (“ah , feel that [gentle] stretch”), as well as breathing and relaxation. After a few courses, I was able to bend as far as the instructor, without any prodding or pushing. The philosophy I learned from her is that it doesn’t matter how you look when you’re doing yoga. What matters is how you feel when you’re doing yoga. Yoga is supposed to feel good.

Nowadays, when you go to a yoga class– even a prenatal yoga class– you get the impression that the instructor is focusing on getting the students to achieve “proper form”, even if it is their first time coming to the class. This is especially difficult for pregnant women, who are at increased risk of injury due to loosened joints. The emphasis seems to be on how you look when you’re doing yoga rather than how you feel.

The instructor I had the conversation with the other day agreed that the emphasis on appearance was off base. She mentioned a yoga workshop she went to recently that was extremely fast paced where stretches were done quickly like warm ups and aerobic exercises. She felt that it was the westernization of yoga as adopted by American culture that made yoga seem like a competitive sport that is packaged and sold like any other commodity.

My question is, do you agree that students should not attempt to do a pose exactly as the instructor does it, unless they feel comfortable doing it? Is it alright for people to go only as far as they can, even if the version of the pose they are able to achieve does not appear “correct”, graceful, or attractive?

Hi Ariele, I like running, I am a capoeirista AND I practice yoga. At least I don’t also ride a horse! I have been active for half my life (I am now in my early 30s). I found your article very clear and well-written. I never had issues with joints but suddenly I feel like every other joint is starting to complain. Recently I have a slight pain in the front and outside of my hip. Some movements related to internal and external rotation of the femur can sometimes (not always) cause a minor nervy feeling in the toes and after reading up on FAI, I do think this is the culprit. I also have a slight lumbar lordosis which is probably also causing further impingement at the hip. Although ashtanga yoga early in my life could have contributed to this, I also think yoga in general has really helped me have a deeper understanding and feeling of the anatomical workings my own body especially as I have delved deeper into the anatomical mechanics of asanas. I am currently planning to see an osteopath, but other than learning proper techniques for moving, I was wondering if there are diet-related changes that can be undertaken to treat/ manage FAI holistically?

Hi @joanne. It is possible you have a hip labral issue or FAI, but the osteopath can give you a solid diagnosis. I’m not a nutrition expert, but since this is a mechanical issue for you, then please see a physical therapist who is familiar with this condition and can get the femur stable in the socket and all the localized stability you will need. Also eat your vegetables. Generally speaking all your joint aches and pains may diminish with an anti-inflammatory diet — low in sugar, processed foods, refined foods and high in colorful and leafy veggies, but that won’t cure the mechanical issue itself.

Thank you for the article on FAI. A few days ago I woke up with anterior lateral hip pain that was worse with walking. The impingement test was positive (pain with combined hip flexion, internal rotation, and adduction). I was on vacation and did the planned hike that day, probably not so smart. I taught a yoga class the following evening and then took 2 rest days. It has improved but is not gone. By the way, I am also a physical therapist and a yoga teacher!

Hi Lynnea, awesome that you are a PT and yogi! not so great that you had a positive impingement test. I’d go straight to gluteal strengthening and rotator strengthening — low and slow — low load, slow but many repetitions. As you know, your symptoms trump any “diagnosis” so go see a great PT if you need 🙂

Thank you, Ariele! As a designer, I agree with this. It’s actually pretty lazy design work, too, if you think about it! They’re abusing all of the meaning of the symbol by forcing an association between it and your brand/marketing campaign, etc. I hope you found someone else to work with! If not, email me at cgelula@gmail.com!

@carriegelula:disqus thank you for your comment — I totally agree, and the manipulative association is just weird. Yes, I figured something else out for the first round, but I’ll definitely reach out to you when i need future design work!

This really speaks to me as I try to find a yoga studio/teachers in a new city. I am holding onto past likes and teachers and probably need to let go, but I want to stay true to myself and not give in to their style just because it’s convenient. I do believe there’s a yoga style and teacher for everyone.

@mary_holman:disqus I’m so glad this post resonates for you. It sounds like you are already in the midst of some self-reflection, so I have 100% confidence you’ll be able to do that within yoga classes too. If you give it a good go (asking friends for recommendations, reading yelp reviews) don’t end up finding someone local whose teaching you click (clique?) with, then know that there are tons of great streaming or otherwise online classes available these days too!

Thanks for this great article! I am 42 years old and have started experiencing anterior hip pain in the last 4-5 months. -mine is more medial than lateral– I first noticed it in external rotation–when sitting cross legged– a dull ache– so I started propping my knee in this pose. it’s getting worse and I’m noticing it after yoga and running. I am a yoga instructor and have a varied practice. I think it’s the running that has caused it–I have been running a lot in the past year. Does this sound like FAI? My intuition has been telling me to increase glute and hip rotator strength. Does this sound correct? I want to take care of this early so as not to cause more problems. Is it something I need to get looked at at this stage or can I do some things on my own? Thank in advance for your help!

Hi Colleeen, only diagnostic imaging (or a scope) can diagnose FAI, since it’s a bone-on-bone impingement. I’m afraid I can’t say anything other than it doesn’t sound healthy. << Not too helpful. But what I think would be helpful is finding a physical therapist who can perform a physical exam and give you direction and manual care. You'll need to you can see a PT who has experience with non-arthritic hip conditions (as I suspect you are too young for a typical arthritis). If you are dedicated to your PT exercises, and you get very targeted exercises, you may not need many PT visits. Plenty of hip injuries occur from running, so please do get some medical attention -- at the very least so it doesn't get worse! (and let us know how it goes!).
(P.S. Thanks for your patience on my response -- I was out of the country leading a retreat when you posted).

Hi @colleengavan:disqus somehow i didn’t see this comment earlier (i was out of the country with limited internet when you wrote). It *could* be a labral tear, but if you had impingement (the “I” in FAI) you would probably feel pain / pinching laterally in sitting cross-legged. Don’t hesitate to see a good physical therapist who has treated hip issues in athletes before. And let me know how it goes!

@colleengavan:disqus I have a classic FAI and have surgery scheduled next January. In fact, I had the same condition on my other side and had a successful surgery a few years ago. I actually started a frequent and regular yoga practice after my PT rehab finished and the join was still stiff. And I’ve been hooked on yoga ever since. I digress. Sorry.

Related specifically to your comment, currently I experience a similar, dull pain when sitting cross legged. And I felt it before the first surgery too. I would describe the pain as coming from my groin area but the main difference between pain felt upon internal rotation is that the pain associated with the external rotation (e.g. sitting “indian style”, etc) is dull but can be made worse and more sharp by continuing to extend the leg out. It’s more of a gradient of pain, whereas the internal rotation is more acute and sharp. When I feel pain on internal rotation it causes me to kind of “jump” and wince. In regards to the cross legged pain I also place a block under the affected side and in Supta Baddha Konasana too.

@arielefoster:disqus, I’ve scoured the internet for an explanation to the cross legged pain that I’ve had with both impingements and your comment about lateral pinching is the only one I’ve come across so far. Can you elaborate a bit on the pathophysiology? Thanks!

hi @sampardo:disqus – the simple answer is that your hip is not very stable in the socket with a torn (or compromised) labrum. This is occurring on the millimeter level. The instability could be causing a much more mild labrum pinch posteroo-laterally in external rotation (seated cross legged) or it could be that your bone is hitting bone in that position (due to thickened femoral neck or “pincer” formation at the rim of your acetabulum).

@arielefoster:disqus Thanks for the quick reply! I really enjoyed this post and the ensuing discussion. Most informative and productive comment section ever.

I want to share a bit more about my experience with FAI for others that stumble upon this post like I did. As I mentioned above I will be having my second surgery this January to shave down the “bump” on my acetabulum. There is no definitive way to diagnosis the cause of a labral tear and associated hip pain as I’ve learned from discussions with my medical team and as Ariele has outlined above. At the time I had been commuting by bike to and from school, taking latin dance classes, and playing intramural basketball. I had also been very active athletically, including running, for 15 years.

Steadily over the course of 6 months the pain was increasing and my mobility was decreasing. During that time I also saw a physical therapist who actually diagnosed the impingement before the orthopedist who overlooked it entirely (I had to insist on the x-ray that brought the condition to light). The acetabular irregularity was plain as day and something that I could even see without any training in x-ray interpretation. That is why I decided to greenlight the first surgery. The surgeon repaired my torn laburm and shaved down the acetabular “bump”. The curve on my acetabulum afterwards was gorgeous–perfect and smooth.

The rehab wasn’t easy. That same physical therapist from before the surgery guided me through 3 grueling months of PT. Surgery isn’t always guaranteed to provide a successful resolution to whatever is ailing you but it proved to be the right thing for me. I recovered nearly 100%. The joint was still stiff after the 3 months of therapy concluded and that is when I started practicing hot yoga religiously and I haven’t looked back.

Now I’m looking forward to the second surgey with my other hip experiencing that same type of steadily increasing pain and decreasing mobility from that same type of impingement (x-ray from first surgery showed the same type of acetabular “bump”).

I really do respect and love physical therapists. And I’m grateful that this experience has brought a regular yoga practice into my life. Namaste, l’chaim, aloha. -SP

Hi Dr. Foster, Thanks so much for this article. I was recently diagnosed with FAI and a label tear on my right side, likely due to my years playing soccer. When speaking to the orthopedic surgeon about my activities, I mentioned I was walking and starting yoga in earnest again after 5 years off and on (and 3 babies :-). He agreed on activities to increase core strength but strongly recommended me to drop yoga in favor of Pilates, saying, “static hip stretches are not for you.” Well, I’m willing to give Pilates a try if it will help but I love many aspects of yoga, and can’t see completely giving it up. I’d rather stick with my normal vinyasa practice and modify where necessary. Do you have some thoughts as to a) how I can modify the hip stretches or what I could do instead? and b) if it’s just the hip stretches, or do I need to be equally as wary of warriors, chair pose, etc? (Guess I could always use pain as my guide there, I just don’t want to do any further damage.) Any thoughts or references would be greatly appreciated!!! Adria

heya @adriareutzel:disqus. Yep, soccer can do it. being active in any way puts us at risk. Here’s the thing about what your doctor stated. Most yoga practices these days are not “static”, certainly not vinyasa. And i just met a super body-aware lady who tore her hip labrum doing reformer pilates (hip adductor moves). So switching to pilates isn’t necessarily the only answer. But I will say that some of the moves from a skilled (Polestar Pilates-trained, if you can find one) pilates instructor could teach you compliments to yoga. I do pilates about 1x/week and love it, and I teach many pilates moves in my classes. I cannot give personalized advice to you (every labral tear / FAI is different — also listing modifications and options would be a whole blog post in itself) but please please go see a yoga-knowledgable PT who can take you through some moves. Then let me know how it goes!

Don’t go to PT school. That’s my advice now to a 19 year old shadowing me. Don’t do it and don’t think about it.

Then the rah rah team tells me I shouldn’t discourage. Really?

The debt is insurmountable. 100-200K for a start of 60-70K. The nonsensical “but I really want to be a PT” is utterly devoid of any forethought. I really want to be a full time writer. You don’t see me winging it in LA. It is not only not strategically smart but naive to think 150K in debt will bring you happiness if you love the job. That’s 250K with interest.

And that brings point 2: The job. I’m a traveler because that is the only way I can keep control of new mergers destroying clinics. Most therapists, who are largely charlatans, and have been for many years see two at a time in OP and multiple patients in skilled. They let techs do treatments in inpatient and outpatient. That is most of the field. 80% at least. I get that figure because I turn down 4/5 contract offers. And it’s based on working across the country for 15 years. Trust me it is accurate. The fact I say it out loud that this profession is unethical bothers most PTs—-and is irrelevant—because it is a fact. So that’s how most of you will work—due to lack of guts and ethics.Most will be living in a career they hate. And even the few of us doing it right (possibly this blogger it seems)–it is still a bureaucratic mess. It is unwinnable now. We used to say the system will break—it is now broken. Treatment is no longer our best—many times it is the best we can do.

In 1995 in my volunteer hours I would tell the 19 year old to go ahead and go to PT school. Not now and most likely not ever again. So heed my advice or golly gee go because you really want to be a PT.

And you’ll be living in a large house of regret.

FYI–yoga alone would solve most problems as most chronic pain is lifestyle—-we really have become quite ridiculous thinking we can solve the chronic pain of the person who is 100 pounds overweight. And in modern PT that person is half of your list–good luck with that

@charles_hurst:disqus i really appreciate your insights here. You bring up some good points: the semi-ridiculousness of a doctoral degree in a field with ever-lessening reimbursements, clinics run unethically / with a view only for profit, practitioners who are juggling patients to keep up with demands and perhaps ignoring evidence and not individualizing treatment (IMHO largely because of pressure of the medical model, not because people who become physical therapists want to be “charlatans”). It’s disheartening. You could say the same about many industries (yoga studios and yoga teachers have similar challenges). However, the difference with physical therapy is the deep resources that you must allocate in time and money to become a physical therapist, so the disappointment you may feel at the end of that road is deeper. There are paths out of that despair, but you have to seek out the best environments (which as you point out are few and far between)… Mine is still evolving, but I gave up a benefitted full time PT position after less than 2 years post-graduation because I could not be a genuine practitioner (and human being!) in that unhealthy poorly-run environment. I took a huge risk with the vast majority of my student debt still hovering, and accepted a PRN (hourly, promised only 10 hours / week) position at a highly respectable and fairly well-run clinic that pretty much only sees patients one-on-one. It’s still within the medical model (a teaching hospital), and I was only able to do it because my rent was reasonable, and I had a little extra income from yoga teaching, but it was the ONLY way for me to avoid burn-out. I’ve now opened my own tiny practice and continue as a PRN clinician at the teaching hospital. My private clinic is bare-bones, no fancy machines, just honest good one on one treatment for an hour at a time. my patients are happy and I am happy (and although they pay me upfront what I request, after getting reimbursed from their insurance companies, many are paying less than their co-pay would be at clinics that accept insurance). I am carving my own path. It’s nothing like the Newsweek “Top Job Satisfaction Report” surveys would indicate about physical therapy jobs, it’s more like I’m an entrepreneur, which is another skill entirely. and pre-DPT students need to be aware that they might have to carve their own path as well.

Yep–and it’s sad as I know a few yogis (one who saved me from chronic insomnia as I now do yoga with my regular regime) who dropped traditional PT for exactly what you describe.

I was lucky–pure and simple.I got out of the military after one tour in ’95 and took the pre med for two years then PT school for 2 years If it had been a doctorate back then I can promise I wouldn’t have taken even Chem I but would have become a cop. And I would have done well with that too. But I only got 38 K in debt and it was gone easily in five years. I stay a travel contractor now solely so I can keep control. Even if I find a decent clinic it could change on a dime with new management or CEOs or takeovers—so I don’t hire on ever anymore. And I’ll probably stay until there is nothing left at all in the field. I’m young so to speak but could get out in 4 years and vanish in south america if I wanted because I’ve been contracting for so long.

Glad people like you are out there—if it ever falls apart with your studio you could travel and not pay rent—three years you could clear 100K off the debt –easily if you live smart. Generally I put away 35-40K a year traveling in remote areas like maine, alaska and wyoming.

I’m surprised the PT field hasn’t gotten crushed by ACA—I wonder how much time we have before it does. Glad someone out there sees it–good luck Ariele.

Yay! Glad you found yoga helpful, @charles_hurst:disqus . I wanted to add that I had in-state tuition for grad school, and that was the smartest decision I ever made. I remember little tears forming in my eyes when I turned down Duke University (#3 PT school in the country and i fell in love with it on interview day), but that would have been a recipe for indentured servitude as I would have faced over 100 K in debt (while living in a very expensive city since I’m back in DC).

Traveling PT is a great option for many (also you learn what is acceptable / not acceptable to you in clinical settings) — not so great for me as my sweetie would miss me and vice versa. Also it would be hard to hold down the yoga teaching, but I love Alaska and adventure would hop on it if my lifestyle and aspirations were different.

It’s also true that the ownership of my current hospital clinic may shift in the future. I’d say generally to anyone in any job anywhere: don’t count on it forever.

But I don’t overtly discourage people from PT school: i just advise 1) in-state tuition 2) no matter where you end up, see yourself as your own boss 3) be frugal financially otherwise that indentured servitude (even with relatively low debt) is crushing and 4) don’t do it for financial gain or financial security.

Hi @disqus_s7WfvnwU8D:disqus, I’d close the practice with grounding and introspective poses like forward folds. You don’t necessarily need more twists after so much twisting, but a nice anandabalasana (Happy Baby pose), Paschimottonasana (seated forward fold), and the like will round out this sequence before meditation or savasana.

Wow! Do I ever resonate with your post, Ariele! And particularly because I am coaching a young woman who is studying to be an Ayurvedic Teacher, and I am learning Sanskrit terms. It’s the first time I’ve been aware of the meaning of an “ayurvedic practice.”
I first became aware that I had less energy when I was in my late 30s. I just couldn’t pull off all the things that I did in my early adult years. But at the same time, I also became aware that, instead of focusing my energy into a lot of different channels, I wanted to focus it more into one primary new channel – transitioning into a new line of work, with an advanced degree and other career credentials. There were other things that remained “primary” for me (like my family/children), but I refined my career focus and also began to focus more on self-care.
I’m still evolving many years later. That’s why your post is so relevant! With brahmacharya or “energy conservation,” I have more awareness of every precious moment. Thank you for the post – and some important reminders!

thank you for this article…I have pain in my LCL which is strained in half lotus, and therefore a lot of my Mysore practice. I particularly like the idea of trying to lift the leg without the hands or arms. My teacher thinks I am making the pain up…that it’s in my mind and rather than encourage me to rest (I did modify all half lotus postures for 2.5months to no avail) he thinks I need to work through the pain. Any advice greatly appreciated.

@claireyogagogo:disqus my short advice is 1) strengthen and stabilize your hips through their entire range (you’ll need some cross-training other than Ashtanga) and 2) definitely don’t push through pain! I’m currently writing an article for my YogaAnatomyAcademy.com blog post on this very subject. May I quote what you wrote above in it (anonymously)? Feel free to message me! (I would love any quotes!)

Thanks for the reply Ariele! Yes, please do quote and it would be so amazing for someone to look into the LCL injury with Lotus/Ashtanga as it is much rarer than the MCL and you can find lots of information on that pain, but outer knee pain is almost overlooked – and I have trawled the internet looking for help! Many thanks for your advice. I am working on opening the hips using Fire Log pose, pigeon and Cowface Pose, also stretching the IT band and using a Lacrosse ball to massage that out. I know it time and am trying to ‘trust the process’ 😉 any further cross training you can recommend gratefully accepted

@claireyogagogo:disqus hi again :). I love the lacrosse ball massage (self myofascial release) — make sure to get all around the hip, calf and lateral quads. Note that the three poses you mentioned as well as stretching the IT band are all passive stretches of the hip — potentially useful for continuing Ashtanga yoga, but they are not compliments of the practice. To compliment the practice you really need stabilizing actions in that deep range. For example: you could do a very active (Anusara-style) eka pada raja kapotasana (pigeon) or super slow motion, standing knee bent half moon warrior two back and forth tracking the knee. You can also give manual resistance with your hands into external rotation of the hips in many seated positions, but please focus on STABILIzing hips (sorry for all caps, i’m just passionate!), not just stretching. Make sense? Much luck to you that you may continue to do what you love.

Yes, thank you for sharing what tpyically ends up on your plate! Keeping it simple and nutritious is my strategy, pescetarian technically here too. I enjoyed reading your description of ambiverts in the brahmacharya post, I consider myself in that category but hadn’t thought about it previously. Some days the pile of laundry waiting for me to put away feels like a burden but I recognize that there’s only so much time in the day. Playing and practicing is more fun and rewarding!
We raise chickens so part of my process to make breakfast includes walking out to the coop to visit our hens. Taking care of them is an enjoyable part of the process too. We usually bring a few eggs to scramble for breakfast at YogaJam, breakfast of champions, right?! You’re welcome to join us if we are able to catch up 🙂

very cool! I would love to connect with both of you. I’m currently in a DPT program – I did the unspeakable and left a great full time job, but yes I definitely wanted the ability to do patient care – in hindsight perhaps PA would have been more logical. However, I do believe in the field and feel as though I’m going to no doubt have my own practice one day. I see PT as a very adaptable degree, and one which allows for a tremendous amount of flexibility, while the training is a tremendous amount of learning and debt the degree I hope and feel will be versatile. I’ve been a yoga instructor for two years now and also know I’ll do that forever. I hope there is a light at the end of the tunnel 🙂 e-mail me if either of you are at all interested in mentoring a fellow yoga instructor + PT perhaps? rsalexan1@gmail.com

@disqus_QYwGZYL7Ul:disqus thanks for your comment. I agree it’s a fairly adaptable degree — so long as you work your butt off, have some business acumen, and are not crushed by debt ;). I’d love to keep in touch! feel free to sign up for my newsletter (link is above). best wishes, Ariele

I’m suffering a great deal of pain and was recently diagnosed by a Physiotherapist who said avoid yoga! Wasn’t very helpful and he didn’t explain what to do to h noelp it, only what not to do. I’m at a loss because I want to go on teacher training but I feel unstable and painful. I’m going to find a good osteopath and see what they say. Very interesting article thank you! I really want to sort this out so I can start to improve again.

@disqus_Gto7Mel3Kr:disqus I’m sorry you are in pain. I can certainly see where a Physio might say “don’t do yoga” , as I myself have upset a few patients by saying “maybe don’t run”. We are in a sticky place as healthcare providers for a million reasons. Yoga asana, in particular, can be extraordinarily variable, so “don’t do yoga” is much more time-efficient than figuring out what shapes are ok, which are not, and which teachers / studios / classes move slowly enough to allow you to not re-injure. Yoga can heal, but it could also harm, so your PT was being protective of you.
But on to the good: you CAN do a home practice. Yoga asana doesn’t have to include any particular poses, and nearly everything can be modified. So long as you are getting out of bed every morning there are poses you CAN do that won’t re-injure (at least any more than walking). (or stay in bed and do savasana :)). If you need guidance on what poses those are (or are not), you can see a skilled yoga/PT (including myself via Skype if you are not in DC — see the private yoga tab). if you set up a consult with me, I can also guide you toward safe teacher trainings. (feel free to join my Spain yoga anatomy retreat, too!)
Second, sometimes a private consult is financially out of reach: consider attending gentle classes or basics classes, classes with teachers trained extensively in therapeutics, or even taking yoga via online streaming sites like gaia.com, yogaglo, etc. what I ADORE about online classes is that i can press pause, go back, or skip poses that just don’t feel awesome in my body. It’s totally liberating and pressure-free.
Finally, in the event that you feel that your physical therapist is not listening to your goals (which sound like your goal is to do more yoga asana), find a new one! MY job as a physical therapist is not to get everyone doing exactly what I want them to do. It’s to help improve your quality of life as defined by you.
This is essential. I highly recommend the therapists certified by the Institute of Physical Arts, and if you can find one of their Certified Functional Manual Therapists in your area, you will be in luck. They tend to be very holistic.
best wishes! don’t hesitate to ask more questions!

I have just been diagnosed with CAM impingement (I believe this means my femur head is not smooth and round and doesn’t rotate well in hip socket) and a detached labrum at 3 o’clock (but not sure whether this means the left or right side of lateral labrum).

I am devastated. I practiced yoga (until I started having pain in right hip which is referring pain to major muscles in both thighs) and I like to walk at least 5 miles per day and hike on mountain trails. I am so worried I will have to give these life choices up which I know will lead to depression (I walk and do yoga as natural therapy to keep depression at bay and to keep me “fit”. )

I do not know if I should have surgery or not – it seems very invasive, and from what I can gather, is not wholly supported by research that surgery is actually helpful. But, I cannot find answers as of yet since I have been told it may take up to a year to even get an appointment with an orthopaedic surgeon.

Hi @disqus_IuhiJv97Uu:disqus : go to physical therapy (someone who spends 30 min or more with you 1 on 1). It might take a while (3-6 months perhaps to feel normal-ish again), and yes, you will *likely* have to modify your activity significantly for 6-12 months. If you are not a good match with your first PT, then don’t hesitate to find another (I try and work with CFMTs or those who have done extensive training with the Institute for Physical Arts, but there are many incredible schools of PT out there). Don’t presume “depression” because your life changes. Life WILL CHANGE. It’s our only guarantee. And many many vibrant human beings live full, satisfying lives without use of their legs at all :). There are infinite ways to stay active and be in nature, this is an OPPORTUNITY to explore more of them. best wishes, ariele

I have been teaching yoga for 5 years, and practicing for 14. One week ago I underwent hip arthroscopy to repair a torn labrum, torn ligamentum teres, fai, and ischioforal impingement. After two years of slowly eliminating positions from yoga, I had to completely stop practicing, and I lost the ability to run(my other love) or cycle. I tried pt (of course) for 6 months, activity modification,chiropractic care, and steroid injections. Nothing worked. It felt like defeat to have surgery. My surgeon, one of the best in the nation for hip artho, said I had a severely swollen femoral head, a “yoga hip” he called it. Hope this info helps someone…I have a background in exercise science, id like to think I understand anatomy and physiology pretty well, and was more than compliant with pt. Overall, the whole thing is a bummer, and I fear I won’t be able to return to yoga. I’m pretty devastated. Yoga saved my mental health, and i wanted pt to be enough, but I guess unfortunately for some, it cannot be. Eventually, we had to discontinue pt because it was flaring up my symptoms. My pt is a yoga student of mine, very invested in the success of it, I think she was devastated too.

Thanks for sharing your story @jenniferthorntonbrooks:disqus . Surgery is definitely not defeat. Your body will calm down, and needs rest + recovery. The best advice I can offer is be patient with your recovery. Offer up to yourself the widest definition of yoga that serves you. Your body doesn’t have to serve yoga. Maybe find a PT who has some personal or deep professional experience with hip FAI and reconstruction. It shouldn’t aggravate your issues. I wish you all the best!

Sorry, I meant that the PT BEFORE surgery had to be discontinued because it was causing flare ups. I am still in post-op PT. I guess I am saying that sometimes there is no other recourse than surgery. I hate hearing that if you get injured in yoga, it is because of your “ego”. That is just a lie, and it is a straight-up mean thing to tell the injured person. Yoga is physical activity that can result in injury. People should also be aware that it is difficult for seasoned yoga practitioners such as myself to recognize the ROM boundaries they should not surpass. My symptoms only arose AFTER a pose, not during it. When you have a degree of flexibility, it is very hard to feel where good ends and bad starts.

OMG YES, @Jennifer Thorton-Brooks , preach. If you look through my comments here, you’ll see me offer similar statements: it doesn’t matter if you cycle, run, soccer, capoeira, martial arts, these things happen. “Listen to your body” and blaming one’s ego if things don’t work out ok literally does not make scientific sense. It cannot be our main safety instruction as yoga instructors because… endorphins (etc). Also, it’s rather cruel as you point out. thank you for saying that, too. I see a lot of blaming around injury rather than reality.

I have been diagnosed with labral tear in hip joint just today by CT scan with dye. Waiting on whether Sartorius is also torn. The injury happened 3.5 years ago morning after a “hip opening Iyengar’ class. Been practicing regularly for 20+ years, very flexible particularly with forward bends to extreme of poses. I believe I slowly caused injury without knowing. I practiced in a very conscientious way stopping at the edge, my edge. I can only do therapeutic yoga now. No external rotations or standing balance poses. I have a gentle practice at home and can do some water aerobics. PT re-injures and causes pain for 3+ weeks after. Injections gave 3-4 days relief. Most other exercise I have tried injures hip. Standing for 6+ hours (cooking, etc.) aggravates it. Immobilizing hip is best (bed rest) and stretching spine, tailbone and hot epson salt baths. Meds are part of my treatment when hip gets aggravated. I am waiting for appt to see a hip specialist.
I agree that yoga has been one of the most positive aspects of my life. I am hesitant to talk about this injury because people are so ready to blame yoga. I also would say I do not feel that ego was a factor in my case. I did not feel any pain in yoga class, ever. I am hopeful that yoga can be a part of my recovery, in a very modified way.

Hi Jan, sorry to hear about your recent diagnosis and few years of pain. I would encourage you to keep talking about this injury, no matter how uncomfortable it is. Go into the nuance of the situation. Since yoga is such a vast and variable practice, it’s almost silly to “blame yoga” for such a precise injury. Might we look more deeply at “hip openers” and whether we are practicing them intelligently, or need them at all? yep. I hope you find relief soon. Much gratitude for you for sharing your story. Please check out my youtube channel for lots of gentle / therapeutics practices 🙂 https://www.youtube.com/channel/UCYcuWaNJvjEFrnq2sB9tN0g

My name is Thomas, I’m 23 years old, Information Technology Student which spends a lot of time sit on a desk in front of a computer. I just want to share my story which is the reverse of the stories that I saw in the comments.
So, I’m a sport guy who loves Martial Art, I search for years what problem that I had in my hips because I couldn’t do facial split, high kick or some stuff likes “Reclining Goddess Pose”, it hurted me so much in my hips. In France, doctors don’t really know the FAI, there is a few surgerons, and when I was about 20, I decided to visit one, I did one hips per year, because even walking made me hurt. Surgery saved my life, but during my whole life, I lost a lot, a lot of flexibility.
I couldn’t even sit cross legged or in deepsquat because of spending my whole time sit on a chair. I will resume very fast but one of my Idol talks about Yoga, so I tried, that was hard really, harder than I thought. I did a lot of Yoga since this summer, and it helped me so much to recover some flexibility after 2 years and half after my first surgery. I see a lot of improvement in my balance, in my flexibility, in my mental. I won’t say Yoga saved my life because I’m okay, but Yoga saved my athlete life, I recover better from BJJ & Calisthenics training, I can now sit in deep squat, cross leged, the pose which help the hips opening are for sure my favourite with the twisted pose, I love it so much. I won’t stop Yoga I think but I will search something to improve my Yoga.

I just want to say, surgery can help to reduce the inflammation in your hips and help you to recover better amplitude of movement. Despite of this surgery, I can’t do Reclining Goddess Pose without hurting my hips and I can’t let my feet parallel and wide when I’m standing. But it’s ok, I found another way to transition in pose or to stretch, the FAI reduces the possibility of movement but it shouldn’t reduce your motivation, your determination. Yoga is today one of my best friend.
The key I think is to accept that the F.A.I or your hips problem can affect your practice, you should accept that you never won’t be able to do some pose but whatever, there is a lot of pose you can do so do it ! Focus on things you can do despite of things you can’t !

@thomas Thanks so much for sharing your story and giving people hope. Surgery is needed sometimes. It’s not a quick fix, but it’s mandatory for basic quality of life for some — like you! It’s not a depressing thing if it helps. Just be careful in yoga (always, everyone) with repeated end-range positions (deep stretches). For example, Conventional splits are passive stretches because your body weight presses down. Passive stretching at end range can be harmful over the long run, especially with FAI. To contrast, the active variation of the splits may not look like the splits — front knee is slightly bent so that you can dig your heel in and pull your back knee toward your front heel. Because the muscles from underneath are contracting, you are supported and performing active stretch

My wife and I tried reducing salt intake, although we had no salt-related issues and sodium levels in the blood were well within limits. We wanted to test our ability to overcome the taste-dependency. We were not adding salt, except in cooking. On the first day, we reduced the amount of salt by a “grain” – as small a reduction as possible. We could not feel the difference in the taste. On the second day, we reduced salt by the same amount. Again, we could not feel the difference. We continued until no salt was added in the cooked food. We did not feel deprived. The food did not taste not unpleasant. Eventually, we returned to using salt. I tried reducing added sugar in the same way. I don’t miss added sugar anymore.

It would be awesome if you could create a yoga video-class for those with FAI to do at home. I haven’t been able to do Yoga since I found out I got FAI because non of the Yoga teachers I know, know what FAI is. Having a video of a sample class would mean the world to me!

Hi Paula, good idea, and yet at the same time FAI will show up differently person to person, so it would be difficult to do a class that will work globally for this condition. That said, I have some plans to do some sort of further video-based teaching about this condition, so if you are curious to hear more, please sign up for our newsletter (at the top of this page) and you’ll be the first to know when that happens!

Thanks for an insightful article. I am a yoga teacher, with also a fulltime job as an engineer. I am looking at making the career transition to teaching more yoga, but really, I like working one on one with people vs. group classes and really seeing changes. I have thought about going back to school for PT for years, but it always seemed like such a big commitment both financially and with time (also there are no PT schools where I live which means I would have to be away from my husband for the school year, or we both move and get new jobs – basically just a huge change and commitment). Recently, I heard of a couple yoga teachers who made career shifts going to school for PTA or physical therapy assistant. This is far less intense schooling and way less expensive and apparently if you are a certified yoga therapist and a PTA many insurance companies will cover your therapy services. I was wondering if you have any advice or insights regarding becoming a PTA and using yoga therapy? I do prefer the idea of getting to develop treatment plans and have the independence of being a PT, but thinking maybe a PTA would be a good route also. Plus I could go to school near my house =)

PTA school / profession is not something I’ve very familiar with. I haven’t worked closely with PTAs, but I know here in DC in order for it to be counted as physical therapy legally and for insurance purposes, the supervising PT has to be on site. It’s very limiting. Also the PT decides what the plan of care it, so for it to be “yoga therapy” (a controversial term in itself) it would have to be within the physical therapist’s plan.

Thank you for this article, it’s posted on my FB timeline. This is particularly close to my heart as I am a yoga teacher needing a hip replacement. Approximately 3 years ago I was told I had a tear in my hip labrum and that I would need a THR sooner rather than later. I was only 48 at the time and was scared and confused and definitely was not going to do a surgery that extreme. Well, 3 specialist later, 5 treatments of PRP, and living a very modified social life, I’m over it! I meet with the 4th specialist next week, and can not wait to get out of pain. This injury has given me so much empathy and curiosity. I hope one day I can look back on this experience and know this is how it needed to be so that I can be a guiding light for others in pain and give them access to remain on their mat and in their own power.

Hi Ariele, thank you for this post. I am 32 and I’m a yoga teacher and dance artist. I’ve been having a reoccurring issue with my hips since 2007. For the past 5 months I have been suffering a major hip pain (can’t trace it to any one incident) and yesterday I have finally been diagnosed with FAI. I have to take a break from both teaching and dancing ;-( because demonstrating aggravates the hip (and sadly when I am teaching it not always works to cue everything verbally…).

Except the asanas which you mentioned above there are also few others which bother my hip: extended angle pose, revolved side angle, happy baby pose and a a whole bunch of others… I would love to hear more about postures which you might recommend for someone with FAI, although I imagine what might be good for one person may not be great for another. I am trying to find my own personal flow for this issue but even transitions in surya namaskar can be painful. I’d love you to make a video with your suggestions for this – it’s a brilliant idea! Thanks again for the article. x

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